HCFA bows to physicians' pressure, will revamp E/M rules
Responding to physicians' protests, the Health Care Financing Admin- istration has agreed to revamp proposed Medicare guidelines for documenting evaluation and management services. HCFA has also indefinitely delayed the July 1 deadline for using the guidelines.
"We wanted a delay, and we got it. We wanted a pilot test, and we got it. We wanted a complete overhaul, and it appears we got that as well," said AAFP President Neil Brooks, M.D., of Rockville, Conn., after an April 27 meeting in Chicago on the guidelines.
"We are pleased with the result of this meeting, but we are still cautious about the ultimate outcome," said Brooks. "We'll continue to respond to our members' concerns."
Brooks earlier lashed out against the guidelines, calling them too flawed to be fixed (see Readers' Forum, below). He said they interfered with patient care and were an insult to physicians.
Fraud/abuse issues
The AMA called the April 27 meeting to address problems with the guidelines, which the AMA and HCFA had developed.
Meeting participants received a letter from HCFA Administrator Nancy-Ann Min DeParle. "Many physicians fear they will be unjustifiably targeted for fraud and abuse investigations as a result of simple coding errors," she said. "Physicians will not be punished for honest mistakes, and we will not make referrals to the Office of Inspector General for occasional errors."
New framework
The AMA CPT Editorial Panel, which has responsibility for the current procedural terminology used for Medicare reimbursement, is developing a new framework for the E/M rules.
The 300-some meeting participants welcomed the panel's draft framework, which is subject to change. It included these improvements to the flawed guidelines proposed in 1997:
- The general multi-system exam chart and 11 charts for single organ systems in the 1997 guidelines would be merged. Physicians would record on the one chart only the elements pertinent to the patient, as the AAFP has suggested.
- The 1997 guidelines contained the presumption that physicians would cover all elements in a comprehensive exam, although physicians were not told to document all elements. The new framework would eliminate that presumption -- an improvement because some elements don't fit all patients. For example, a digital rectal exam is inappropriate for most youngsters.
- A much more understandable approach would be used for determining the complexity of medical decision making.
AAFP Past President Douglas Henley, M.D., of Fayetteville, N.C., a member of the CPT Editorial Panel, presented the draft framework at the meeting. The participants gave feedback, and the panel planned to revise the framework in May and request comments from physician organizations.
In August, the panel will probably finalize the framework so it may be tested. HCFA is expected to delay the implementation date until the pilot test can be analyzed and physicians, their staffs and Medicare carriers can be trained to use the new guidelines.
In the meantime, physicians may submit claims using the proposed 1997 guidelines or those in force since 1995.
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.